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MFM Oral Boards 2020 > Critical Care Exam Pro > Flashcards

Critical Care Exam Pro Flashcards

1
Q 
Hemodynamic changes in pregnancy 
CO
HR
LVSWI
SVR
PVR
MAP
PCWP
COP
A 
CO +43%
HR + 10%
LVSWI +10%
SVR- 20%
PVR- 30%
MAP +4%
PCWP +30%
COP -14%
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2
Q

PCWP in pregnancy

A

6-12

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3
Q

CVP in pregnancy

A

4-10

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4
Q

PVR

SVR in pregnancy

A

PVR- 55-100

SVR 1000-1400

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5
Q

LVSWI

A

40-55

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6
Q

who class 1

A

No increased risk

small PDA, Mild PS, repaired simple lesions, ectopic beats

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7
Q

who class 2

A 
mortality 5-15%
ASD/VSD
repaired tet 
arrythmias
mild left ventricular dysfunction 
HCM
biprosthetic valve 
repaired coarc
Marfan with aorta <40 mm
BAV with aorta <45 mm
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8
Q

who class 3

A 
mortality 25-50%
mechanical valve
systemic RV
cyanotic heart disease
complex CHD
BAV with aorta 40-50 mm 
Marfan aorta 40-45 mm
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9
Q

who class 4

A 
severe MS
severe AS
BAV with aorta >50 
Marfan with aorta >45
EF <30%
severe coarct 
severe pulmonary hypertension
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10
Q

Cardiac C/S indications

A

aortic >40 mm
AA
recent MI
severe symptoms aortic stenosis

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11
Q

pulmonary hypertension

A 
25-30 mmhg
lower mortality <50 
lower motality with idiopathic vs cardiogenic
Delivery mod/severe 32-34 weeks
mild  35-37 week deliv
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12
Q

pulmonary hypertension treatment

A

ca channel blocker
NO
prostacyclin derivatives
sildenafil (phosphodiesterase inhibitors)
Endothelin receptors blockers are teratogenic

enhanced treatments for at least 3 months

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13
Q

what to give for PEA

A

epinephrine

atropine

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14
Q

marfan treatments

A

ppx b blocker

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15
Q

pp cardiomyopathy definition

A

EF<45%
fractional shortening <30 %
left ventricular end diasolic dimension >2.7cm/m

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16
Q

pp cardiomyopathy treatment

A 
O2 
reduce afterload- hydralazine
improve contractility- dig 
Reduce Myocardial demand
- beta blocker 
ppx anticoagulation
- wearable cardioverter
- LVAD
- ECMO
  • recovery 50-75%
    AA 20-45%
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17
Q

mortality with subsequent pregnancys with a history of PPCM

A

recovered- 20% reoccurance 0% mortality

decreased function
- 40-65% will have reoccurance
15% mortality

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18
Q

In general what are high risk maternal cardiac lesions

A

aortic regurgitation/mitral regurg with NYHA class III/IV
Marfan syndrome (expecially with aortic regurg)
Severe aortic stenosis <1.5 cm, gradient >30 mmhg
Severe Mitral Stenosis <2 cm
LV dysfunction (pulmonary hypertension, EF decreased,
Mechanical valves
Poor functional class or cyanosis

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19
Q

Goals in sepsis

A

CVP 8-12
MAP> 65 mmhg
normalize pulse
uop >0.5ml/kg/hr

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20
Q

SIRS

A

Fever, tachycardia, tachypnea, leukocytosis, mental status change, hyperglycemia

21
Q

Septic shock

A

hypotension persists despite adequate fluid resuscitation

22
Q

Severe sepsis

A 
sepsis wih organ dysfunction 
O2 requirement
Oligouria
Elevated creatinine >1-2
Hypotensive
Plt<100,000
Lactate>2 (>4 very bad)
Bilirubin >2
INR>1.5
23
Q

sepsis

A

SIRS from septic shock

24
Q

Sepsis treatment

A

fluids 20-30 ml/kg/hr
start with 20 and repeat as needed with 500 cc/bolus

-pressors as needed ( norepi)

25
Q 
Lung volumes 
TLC
VC
RV
FRC

changes in pregnancy

A 
TLC- total 
VC- how much can be exhaled
RV- left after VC
FRC- left after normal breath 
ERV- FRV- RV
decreased ERV/FRC/ RV
VC preserved
Incrased TV
RR unchanged
minute ventilation > 50%
  • avoid over ventilation goal pCO2 30-32
26
Q 
pregnancy ABC
PaO2
PaCO2
HCO3
pH
A

PaO2- 101
PaCO2-up to 32
HCO3- up to 21
pH- 7.4-7.45

27
Q

DDX of dyspnea

A 
allergic reaction 
aspiration
pulmonary edema
PE
AFE
maternal heart disease
28
Q

mild asthma

A

<1 hour
<2 episodes/week
PEFR>80%

29
Q

mild persistant

A

> 2x week

30
Q

Immunospressive medications in pregnancy

A

immunosuppression regimen in pregnant transplant recipients is the combination of a CNI (either tacrolimus or cyclosporine), azathioprine, and low-dose prednisone

The use of mycophenolate mofetil, sirolimus everolimus- not recommended

31
Q

SLE treatment pregnancy

A

hydroxychloriquine
-prednisone

  • can consider tacrolimus, cyclosporine, azathioprine
32
Q

zahara score

A 
arrhythmias 1.5
NYHA class II 0.75
Left heart obstruction 2.5 
Cardiac medication 1.5 
Systemic AV valve 0.75
Pulmonary AV valve 0.75
0-2.9%
0.5-1.5 7.5%
1.51-2.50 17.5%
2.51-3.50 43.1%
>3.51 70%
33
Q

Carpreg

A

Prior heart failure, TIA, stroke before pregnancy -1

NYHA III/IV -1

Valvular and outflow tract obstruction
AV<1.5, MV <2 LVOT gradient >30 - 1

Myocardial Dysfunction
LVEF <40%, Cardiomyopathy -1

Mortality
0- 5%
1 - 27%
>1 -75%

34
Q

NYHC

A

1- normal
2- fatigue with physical activity
3- fatigue with daily life
4- uncomfortable at rest

35
Q

Bacterial endocarditis ppx

A

prosthetic heart valve
prior infective endocarditis
unrepaired congenital heart disease
repaired CHD for 6 months after repair with prosthetic material

  • discuss with cardiology
    ppx is ampicillin
36
Q

why is vaginal delivery perferred in cardiac disease

A 
decresed blood loss
decreased pain
decreased fluid shifts
decresed immobilization
decreased thrombosis
37
Q

how do you alter labor management with cardiac disease

A

labor in lateral decubitus

“slow” epidural (maybe not aortic stenosis)

38
Q

work up for palpitations

A

EKG
thyroid
UDS
- caffeine, smoking, alcohol use

39
Q

Pulmonary hypertension for esingmenger pearls

A

decreased SVR will cause worse R to L shift and potentially death due to lack of oxygenization

NO/intravenous prostacyclin reduce PVR
Anticoagulation

delayed death can be seen 4-6 weeks

40
Q

Non-cardiogenic pulmonary edema

A 
preeclampsia
ARDS
Sepsis
DIC
TRALI 
Anaphylaxis
AFE
41
Q

Cardiogenic reasons for pulmonary edema

A 
CHF
Cor Pulmonale
Myocardial infarction
CHD
Aquired valve lesions
Ischemic heart disease
Dysrhythmias
Hypertension
Intravascular overload
B mimetic 
multifetal
42
Q

what is ARDS

A

decreased lung compliance with massive intrapulmonary shunting

  • in OB likely infection

P/F ratio <200

43
Q

P/F ratio - looking for intrapulmonary shunt

blood flow but lung that is not oxygenated

A

PaO2/FiO2 x100 =P/F ratio

high -good
low- bad

44
Q

Inital Vent settings
SIMV

Goals

A

Rate 14-16
Tidal volume 6-10 ml/kg
PEEP 5

Goals: PaO2 >60
SaO2 >95
PaCO2 30

45
Q

Group A Strep

A

most pp
hypothermia
pain out of proportion

Nec Fash
- take out the uterus!

46
Q

Indication for intubation

A 
oxygenation - PO2 <60
ventilation PCO2 >40
maternal exhaustion 
Worsening acidosis
altered conciousness
47
Q

ScVO2

A

how well is tissue being extracted
- >70%

eval by Central venous cath

48
Q

opioids for athma

A

fentanyl

MFM Oral Boards 2020 (25 decks)

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